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门诊机器人辅助前列腺根治术:患者是否准备好当天出院?

Outpatient Robot-Assisted Radical Prostatectomy: Are Patients Ready for Same-Day Discharge?

机构信息

Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

出版信息

J Endourol. 2020 Apr;34(4):450-455. doi: 10.1089/end.2019.0796. Epub 2020 Mar 26.

Abstract

Several case series have demonstrated the safety and feasibility of outpatient robot-assisted radical prostatectomy (RARP) in well-selected patients; however, the patient perspective of this practice has not been well explored. In this study, we explored patients' perspectives on the potential barriers and benefits of outpatient RARP. We developed a multidimensional questionnaire to assess socioeconomic status, presence of caretaker at home, preferred transportation to the emergency room in case of chest pain or postsurgical complications, readiness for discharge at postanesthesia care unit (PACU), and potential barriers for discharge. In addition, patients were asked to provide an estimate of overnight hospitalization costs and their willingness to pay out-of-pocket expenses for their overnight stay. Patients who underwent RARP between August 1, 2018, and April 30, 2019, were asked to fill the questionnaire within the first week following their operation. During our study, 157/292 (53.8%) of men undergoing RARP from a single high-volume robotic surgeon completed the survey. Patients who completed <80% of the survey ( = 5) were excluded from the final analysis. Thirty-seven (24.3%) patients felt that they would have been ready for discharge immediately from PACU, and 48 (31.6%) patients after extended recovery and before midnight. Only 17.8% ( = 27) of the patients claim that they experienced a medical intervention in the hospital that could not have been managed at home. The main barriers for same-day discharge were pain (55.9%, 80/143), catheter discomfort (44.7%, 64/143), insufficient education about catheter care (31.4%, 45/143), postoperative nausea and vomiting (15.3%, 22/143), and medical complications (13.2%, 19/143). Two-thirds of patients following RARP did not feel ready to be discharged on the day of their surgery. Further research is necessary to identify patients who may benefit from this approach to reduce health care costs while minimizing patient postoperative morbidity.

摘要

几项病例系列研究已经证明,在经过精心选择的患者中,门诊机器人辅助根治性前列腺切除术(RARP)是安全且可行的;然而,这种治疗方案对患者的影响尚未得到充分探索。在这项研究中,我们探讨了患者对门诊 RARP 的潜在障碍和益处的看法。我们制定了一份多维问卷,以评估社会经济地位、家中是否有看护者、胸痛或术后并发症发生时首选的急诊交通方式、麻醉后护理单元(PACU)出院准备情况,以及出院的潜在障碍。此外,患者还被要求估算过夜住院费用,并表示愿意自费支付过夜费用。于 2018 年 8 月 1 日至 2019 年 4 月 30 日期间接受 RARP 的患者,在术后第一周内填写问卷。在我们的研究中,在接受单名高容量机器人外科医生进行的 RARP 的 292 名男性中,有 157 名(53.8%)完成了调查。有 5 名患者完成了调查中的 <80%,被排除在最终分析之外。37 名(24.3%)患者认为他们可以立即从 PACU 出院,48 名(31.6%)患者可以在延长恢复期后至午夜前出院。只有 17.8%(27 名)的患者表示他们在医院经历了需要医疗干预的情况,而这些情况在家里是可以得到管理的。当天出院的主要障碍是疼痛(55.9%,80/143)、导尿管不适(44.7%,64/143)、缺乏有关导尿管护理的教育(31.4%,45/143)、术后恶心和呕吐(15.3%,22/143)以及医疗并发症(13.2%,19/143)。接受 RARP 治疗的患者中,有三分之二的人在手术当天没有准备好出院。需要进一步的研究来确定可能受益于这种方法的患者,以降低医疗成本,同时将患者术后发病率降至最低。

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